单纯脑白质疏松症和皮质下动脉硬化性脑病患者认知功能的对比(英文)

A contrast between the cognitive function of patients with simple leukoaraeosis and subcortical arterioselerotic encephalopathy

背景:单纯脑白质疏松症和皮质下动脉硬化性脑病的认知功能是脑血管病神经心理研究的一部分,但目前关于两者的对比研究还是空白。目的:探讨单纯脑白质疏松症、皮质下动脉硬化性脑病及单纯脑白质疏松症合并脑梗死认知功能的不同特点。设计:随机对照观察。单位:山东大学齐鲁医院神经内科。对象:选择1997-03/2000-05在山东大学齐鲁医院神经内科就诊的脑血管病患者91例,均自愿参加观察。按疾病类型分为3组,其中单纯脑白质疏松症组27例,皮质下动脉硬化性脑病组33例,单纯脑白质疏松症+脑梗死组31例。另外选择健康对照组30例。以上各组观察对象均自愿参加观察。方法:对各组观察对象进行认知功能及记忆能力评定,并进行对比分析。认知功能测定采用简易精神状态量表,按不同文化程度(文盲、小学、中学、大学)评分分别低于17,20,22,23分为痴呆。记忆能力测查采用中国医学科学院心理研究所等编制的临床记忆量表甲式,测查内容包括联想学习、指向记忆、无意义图形再认、图像自由回忆和人像特点联系回忆,将上述5项测查成绩换算成量表分并算出记忆商。主要观察指标:各组观察对象认知功能障碍情况及简易精神状态量表、临床记忆量表评分。结果:纳入脑血管病患者91例及健康对照者30例,全部进入结果分析,无脱落。①各组观察对象认知功能障碍情况比较:单纯脑白质疏松症组轻度认知功能障碍21例(77.8%);皮质下动脉硬化性脑病组中度认知功能障碍8例(24.2%),痴呆25例(75.8%);单纯脑白质疏松症+脑梗死组中度认知功能障碍6例(19.4%),痴呆24例(77.4%)。②各组观察对象简易精神状态量表及临床记忆量表评分比较:单纯脑白质疏松症组、皮质下动脉硬化性脑病组、单纯脑白质疏松症+脑梗死组两量表评分均显著低于健康对照组(t=2.14～3.81,P<0.05～0.01)。皮质下动脉硬化性脑病组和单纯脑白质疏松症+脑梗死组评分显著低于单纯脑白质疏松症组(t=2.13～3.37,P<0.05～0.01)。结论:①单纯脑白质疏松症认知损害以轻度认知功能障碍为主。②皮质下动脉硬化性脑病和单纯脑白质疏松症+脑梗死的认知障碍以中度认知功能障碍和痴呆为主,其程度明显重于轻度认知功能障碍。认知功能可以作为评估单纯脑白质疏松症和皮质下动脉硬化性脑病的参考指标。

BACKGROUND： Cognitive function of simple leukoaraeosis （LA） and subeortical arterioselerotic encephalopathy （SAE） is a part of research in cerebrovascnlar neuropsychology, however, there is no contrast study on cognitive function between the two diseases. OBJECTIVE： To investigate the different features in cognitive function among patients with simple leukoaraeosis, subcortical arterioselerotic encephalopathy and simple leukoaracosis combined with cerebral infarction. DESIGN： Randomized controlled observation SETTING： Department of Neurological Medicine, Qilu Hospital, Shandong University. PARTICIPANTS： A total of 91 cases of patients with cerebrovascular disease diagnosed in Department of Neurological Medicine of Qilu Hospital of Shandong University from March 1997 to May 2000 were selected. All the patients participated in the observation voluntarily. They were divided into 3 groups according to the type of disease, with 27 cases in simple leukoaraeosis group, 33 cases in subcortical arterioselerotic encephalopathy group and 31 cases in simple leukoaraeosis ＋ cerebral infarction group. Additionally, 30 healthy cases were selected as control group. All the subjects in the above groups participated in the observation voluntarily. METHODS： Assessment on cognitive function and memory ability was conducted on the subjects in each group, and contrast analysis was performed. Mini-mental state examination was used for detecting cognitive function. Patients whose score was less than 17, 20, 22, 23 respectively according to different educational degree （illiteracy, primary school, middle school, university）, would be diagnosed as dementia. Clinical memory scale A edited by Psychology Institute of Chinese Academy of Medical Sciences was used for detecting memory ability including associative learning, directive memory, recognition of nonsense figure, image free recall and partrait characteristics associative recall. Conversed the above 5 items of detecting results to scores of scales and calculated out the memory quotients. MAIN OUTCOME MEASURES： State of cognitive disorder and scores of mini-mental state examination and Clinical memory scale of subjects in each group. RESULTS： All the 91 cases of patients with cerebrovascular disease and 30 healthy control cases entered results analysis without any drop out. ① Comparison of the state of cognitive disorder among subjects in each group： There were 21 cases of mild cognitive disorder （77.8%） in simple leukoaraeosis group, 8 cases of moderate cognitive disorder （24.2%） and 25 cases of dementia （75.8%） in subeortical arterioselerotic encephalopathy group, 6 cases of moderate cognitive disorder （19.4%） and 24 cases of de- mentia （77.4%） in simple leukoaraeosis ＋ cerebral infarction group. ② Comparison of the scores of mini-mentnl state examination among and clinical memory scale： Scores of the two scales in simple leukoaraeosis group, subeortical arterioselerotic encephalopathy group＇and simple leukoaraeosis ＋ cerebral infarction group were significantly lower than those in healthy control group （t=2.14-3.81, P 〈 0.05-0.01）. The scores in subeortical arterioselerotic encephalopathy group and simple leukearaeosis ＋ cerebral infarction group were significantly lower than those in simple leukoaraeosis group （t=2.13-3.37, P 〈 0.05-0.01）. CONCLUSION： ① The cognitive impairment in simple leukoaraeosis is mainly mild cognitive disorder. ② The cognitive impairments in subcortieal arterioselerotic encephalopathy and simple leukoaraeosis ＋ cerebral infarction are mainly moderate cognitive disorder and dementia which are obviously severer than mild cognitive disorder. Cognitive function can be used as reference indicator for assessing simple leukoaraeosis and subeortical arterioselerotic encephalopathy.